PHTLS - Prehospital Trauma Life Support Airway and Ventilation 2 — Questions and Answers
Question 1: Which airway adjunct is most appropriate for an unconscious trauma patient with an intact gag reflex?
- Oropharyngeal airway (OPA)
- Nasopharyngeal airway (NPA) (Correct answer)
- Laryngeal mask airway
- Combitube
Correct answer: Nasopharyngeal airway (NPA)
The nasopharyngeal airway is better tolerated than the OPA in patients with an intact gag reflex.
The NPA is inserted through the nostril and sits in the posterior pharynx, bypassing the tongue to maintain airway patency. Unlike the OPA, it is generally tolerated by patients with intact gag reflexes. PHTLS recommends sizing the NPA by measuring from the nostril to the earlobe.
Question 2: What is the primary risk of hyperventilation in a trauma patient with a head injury?
- Gastric distension leading to vomiting
- Cerebral vasoconstriction causing decreased cerebral perfusion (Correct answer)
- Pulmonary edema from over-inflation
- Cardiac arrhythmia from respiratory alkalosis
Correct answer: Cerebral vasoconstriction causing decreased cerebral perfusion
Hyperventilation causes hypocapnia leading to cerebral vasoconstriction, which reduces cerebral blood flow and can worsen secondary brain injury.
Carbon dioxide is a potent cerebral vasodilator. Hyperventilation rapidly lowers PaCO2, causing cerebral vasoconstriction. PHTLS recommends normal ventilation rates for TBI patients. Mild hyperventilation is ONLY indicated when signs of cerebral herniation are present.
Question 3: In PHTLS, what is the jaw thrust maneuver primarily used for?
- Opening the airway in patients with suspected cervical spine injury (Correct answer)
- Clearing a foreign body obstruction
- Inserting an endotracheal tube
- Assessing mandibular fractures
Correct answer: Opening the airway in patients with suspected cervical spine injury
The jaw thrust opens the airway by displacing the mandible anteriorly without extending the neck, making it the preferred technique when cervical spine injury is suspected.
The jaw thrust is performed by placing fingers behind the angles of the mandible and lifting forward. Unlike the head-tilt chin-lift, the jaw thrust maintains cervical spine alignment. PHTLS emphasizes that if the jaw thrust alone does not open the airway, a careful head-tilt chin-lift should be performed since airway patency takes priority.
Question 4: What is the preferred initial ventilation method for a trauma patient requiring assisted ventilation in the field?
- Mouth-to-mouth ventilation
- Bag-valve-mask with supplemental oxygen (Correct answer)
- Demand valve resuscitator
- Mechanical ventilator
Correct answer: Bag-valve-mask with supplemental oxygen
Bag-valve-mask ventilation with supplemental oxygen provides effective ventilation with high FiO2 delivery.
The BVM with supplemental oxygen is the mainstay of prehospital ventilation. Connected to a reservoir and oxygen at 15 L/min, it delivers near 100% FiO2. PHTLS teaches that BVM ventilation is often a two-person technique in the field.
Question 5: Which clinical sign indicates a potentially compromised airway in a trauma patient?
- Clear, strong voice
- Stridor or gurgling sounds during breathing (Correct answer)
- Respiratory rate of 16 breaths per minute
- Equal bilateral chest rise
Correct answer: Stridor or gurgling sounds during breathing
Stridor indicates upper airway narrowing and gurgling suggests fluid in the airway, both signs of airway compromise requiring immediate intervention.
Stridor is a high-pitched inspiratory sound indicating upper airway narrowing. Gurgling suggests blood, vomit, or secretions requiring immediate suctioning. Hoarseness may indicate laryngeal injury. PHTLS emphasizes that an awake patient who can speak clearly likely has an adequate airway.
Question 6: According to PHTLS, what is the appropriate oxygen saturation target for trauma patients?
- 88-92%
- Greater than or equal to 94% (Correct answer)
- 100% at all times
- 85-90% is acceptable
Correct answer: Greater than or equal to 94%
PHTLS recommends maintaining oxygen saturation at 94% or above in trauma patients to ensure adequate tissue oxygenation.
This threshold ensures adequate hemoglobin saturation and tissue oxygenation. Patients with TBI should maintain SpO2 above 90% as even brief hypoxic episodes significantly worsen neurologic outcomes.
PHTLS - Prehospital Trauma Life Support Airway and Ventilation 2
Which airway adjunct is most appropriate for an unconscious trauma patient with an intact gag reflex?